7 LONG TITLE
8 General Description:
9 This bill amends provisions relating to POLST orders.
10 Highlighted Provisions:
11 This bill:
12 ▸ renames the life with dignity order as the POLST order;
13 ▸ applies the provisions of the Uniform Electronic Transactions Act to signatures that
14 are required on a POLST order; and
15 ▸ allows a verbal confirmation, under limited circumstances, to satisfy the
16 requirement for a signature on a POLST order.
17 Money Appropriated in this Bill:
19 Other Special Clauses:
21 Utah Code Sections Affected:
23 75-2a-103, as last amended by Laws of Utah 2009, Chapter 99
24 75-2a-106, as last amended by Laws of Utah 2009, Chapter 99
26 Be it enacted by the Legislature of the state of Utah:
27 Section 1. Section 75-2a-103 is amended to read:
28 75-2a-103. Definitions.
29 As used in this chapter:
30 (1) "Adult" means a person who is:
31 (a) at least 18 years of age; or
32 (b) an emancipated minor.
33 (2) "Advance health care directive":
34 (a) includes:
35 (i) a designation of an agent to make health care decisions for an adult when the adult
36 cannot make or communicate health care decisions; or
37 (ii) an expression of preferences about health care decisions;
38 (b) may take one of the following forms:
39 (i) a written document, voluntarily executed by an adult in accordance with the
40 requirements of this chapter; or
41 (ii) a witnessed oral statement, made in accordance with the requirements of this
42 chapter; and
43 (c) does not include a [
44 (3) "Agent" means a person designated in an advance health care directive to make
45 health care decisions for the declarant.
46 (4) "APRN" means a person who is:
47 (a) certified or licensed as an advance practice registered nurse under Subsection
49 (b) an independent practitioner;
50 (c) acting under a consultation and referral plan with a physician; and
51 (d) acting within the scope of practice for that person, as provided by law, rule, and
52 specialized certification and training in that person's area of practice.
53 (5) "Best interest" means that the benefits to the person resulting from a treatment
54 outweigh the burdens to the person resulting from the treatment, taking into account:
55 (a) the effect of the treatment on the physical, emotional, and cognitive functions of the
57 (b) the degree of physical pain or discomfort caused to the person by the treatment or
58 the withholding or withdrawal of treatment;
59 (c) the degree to which the person's medical condition, the treatment, or the
60 withholding or withdrawal of treatment, result in a severe and continuing impairment of the
61 dignity of the person by subjecting the person to humiliation and dependency;
62 (d) the effect of the treatment on the life expectancy of the person;
63 (e) the prognosis of the person for recovery with and without the treatment;
64 (f) the risks, side effects, and benefits of the treatment, or the withholding or
65 withdrawal of treatment; and
66 (g) the religious beliefs and basic values of the person receiving treatment, to the extent
67 these may assist the decision maker in determining the best interest.
68 (6) "Capacity to appoint an agent" means that the adult understands the consequences
69 of appointing a particular person as agent.
70 (7) "Declarant" means an adult who has completed and signed or directed the signing
71 of an advance health care directive.
72 (8) "Default surrogate" means the adult who may make decisions for an individual
73 when either:
74 (a) an agent or guardian has not been appointed; or
75 (b) an agent is not able, available, or willing to make decisions for an adult.
76 (9) "Emergency medical services provider" means a person who is licensed,
77 designated, or certified under Title 26, Chapter 8a, Utah Emergency Medical Services System
79 (10) "Generally accepted health care standards":
80 (a) is defined only for the purpose of:
81 (i) this chapter and does not define the standard of care for any other purpose under
82 Utah law; and
83 (ii) enabling health care providers to interpret the statutory form set forth in Section
84 75-2a-117; and
85 (b) means the standard of care that justifies a provider in declining to provide life
86 sustaining care because the proposed life sustaining care:
87 (i) will not prevent or reduce the deterioration in the health or functional status of a
89 (ii) will not prevent the impending death of a person; or
90 (iii) will impose more burden on the person than any expected benefit to the person.
91 (11) "Health care" means any care, treatment, service, or procedure to improve,
92 maintain, diagnose, or otherwise affect a person's physical or mental condition.
93 (12) "Health care decision":
94 (a) means a decision about an adult's health care made by, or on behalf of, an adult, that
95 is communicated to a health care provider;
96 (b) includes:
97 (i) selection and discharge of a health care provider and a health care facility;
98 (ii) approval or disapproval of diagnostic tests, procedures, programs of medication,
99 and orders not to resuscitate; and
100 (iii) directions to provide, withhold, or withdraw artificial nutrition and hydration and
101 all other forms of health care; and
102 (c) does not include decisions about an adult's financial affairs or social interactions
103 other than as indirectly affected by the health care decision.
104 (13) "Health care decision making capacity" means an adult's ability to make an
105 informed decision about receiving or refusing health care, including:
106 (a) the ability to understand the nature, extent, or probable consequences of health
107 status and health care alternatives;
108 (b) the ability to make a rational evaluation of the burdens, risks, benefits, and
109 alternatives of accepting or rejecting health care; and
110 (c) the ability to communicate a decision.
111 (14) "Health care facility" means:
112 (a) a health care facility as defined in Title 26, Chapter 21, Health Care Facility
113 Licensing and Inspection Act; and
114 (b) private offices of physicians, dentists, and other health care providers licensed to
115 provide health care under Title 58, Occupations and Professions.
116 (15) "Health care provider" is as defined in Section 78B-3-403, except that it does not
117 include an emergency medical services provider.
118 (16) (a) "Life sustaining care" means any medical intervention, including procedures,
119 administration of medication, or use of a medical device, that maintains life by sustaining,
120 restoring, or supplanting a vital function.
121 (b) "Life sustaining care" does not include care provided for the purpose of keeping a
122 person comfortable.
128 (a) is under 18 years [
129 (b) is not an emancipated minor.
131 under Title 58, Chapter 67, Utah Medical Practice Act or Chapter 68, Utah Osteopathic
132 Medical Practice Act.
134 Title 58, Chapter 70a, Utah Physician Assistant Act.
135 (20) "POLST order" means an order, on a form designated by the Department of Health
136 under Section 75-2a-106(5)(a), that gives direction to health care providers, health care
137 facilities, and emergency medical services providers regarding the specific health care
138 decisions of the person to whom the order relates.
139 (21) "Reasonably available" means:
140 (a) readily able to be contacted without undue effort; and
141 (b) willing and able to act in a timely manner considering the urgency of the
143 (22) "Substituted judgment" means the standard to be applied by a surrogate when
144 making a health care decision for an adult who previously had the capacity to make health care
145 decisions, which requires the surrogate to consider:
146 (a) specific preferences expressed by the adult:
147 (i) when the adult had the capacity to make health care decisions; and
148 (ii) at the time the decision is being made;
149 (b) the surrogate's understanding of the adult's health care preferences;
150 (c) the surrogate's understanding of what the adult would have wanted under the
151 circumstances; and
152 (d) to the extent that the preferences described in Subsections (22)(a) through (c) are
153 unknown, the best interest of the adult.
154 (23) "Surrogate" means a health care decision maker who is:
155 (a) an appointed agent;
156 (b) a default surrogate under the provisions of Section 75-2a-108; or
157 (c) a guardian.
158 Section 2. Section 75-2a-106 is amended to read:
159 75-2a-106. Emergency medical services -- POLST order.
160 (1) A [
161 described in this section.
162 (2) A [
163 to consent to the order pursuant to this section, be prepared by:
164 (a) the physician, APRN, or, subject to Subsection (11), physician assistant of the
165 person to whom the [
166 (b) a health care provider who:
167 (i) is acting under the supervision of a person described in Subsection (2)(a); and
168 (ii) is:
169 (A) a nurse, licensed under Title 58, Chapter 31b, Nurse Practice Act;
170 (B) a physician assistant, licensed under Title 58, Chapter 70a, Utah Physician
171 Assistant Act;
172 (C) a mental health professional, licensed under Title 58, Chapter 60, Mental Health
173 Professional Practice Act; or
174 (D) another health care provider, designated by rule as described in Subsection (10).
175 (3) A [
176 (a) personally, by the physician, APRN, or, subject to Subsection (11), physician
177 assistant of the person to whom the [
178 (b) (i) if the person to whom the [
179 with health care decision making capacity, by:
180 (A) the person; or
181 (B) an adult who is directed by the person to sign the [
182 on behalf of the person;
183 (ii) if the person to whom the [
184 lacks health care decision making capacity, by:
185 (A) the surrogate with the highest priority under Section 75-2a-111;
186 (B) the majority of the class of surrogates with the highest priority under Section
187 75-2a-111; or
188 (C) a person directed to sign the POLST order by, and on behalf of, the persons
189 described in Subsection (3)(b)(ii)(A) or (B); or
190 (iii) if the person to whom the [
191 parent or guardian of the minor.
192 (4) If a [
193 sustaining treatment be withheld or withdrawn from the minor, the order shall include a
194 certification by two physicians that, in their clinical judgment, an order to withhold or
195 withdraw life sustaining treatment is in the best interest of the minor.
196 (5) A [
197 (a) shall be in writing, on a form [
198 (b) shall state the date on which the POLST order was made;
199 (c) may specify the level of life sustaining care to be provided to the person to whom
200 the order relates; and
201 (d) may direct that life sustaining care be withheld or withdrawn from the person to
202 whom the order relates.
203 (6) A health care provider or emergency medical service provider, licensed or certified
204 under Title 26, Chapter 8a, Utah Emergency Medical Services System Act, is immune from
205 civil or criminal liability, and is not subject to discipline for unprofessional conduct, for:
206 (a) complying with a [
207 (b) providing life sustaining treatment to a person when a [
208 order directs that the life sustaining treatment be withheld or withdrawn.
209 (7) To the extent that the provisions of a [
210 this section conflict with the provisions of an advance health care directive made under Section
211 75-2a-107, the provisions of the [
212 (8) An adult, or a parent or guardian of a minor, may revoke a [
213 POLST order by:
214 (a) orally informing emergency service personnel;
215 (b) writing "void" across the POLST order form;
216 (c) burning, tearing, or otherwise destroying or defacing:
217 (i) the POLST order form; or
218 (ii) a bracelet or other evidence of the [
219 (d) asking another adult to take the action described in this Subsection (8) on the
220 person's behalf;
221 (e) signing or directing another adult to sign a written revocation on the person's
223 (f) stating, in the presence of an adult witness, that the person wishes to revoke the
224 order; or
225 (g) completing a new [
226 (9) (a) Except as provided in Subsection (9)(c), a surrogate for an adult who lacks
227 health care decision making capacity may only revoke a [
228 revocation is consistent with the substituted judgment standard.
229 (b) Except as provided in Subsection (9)(c), a surrogate who has authority under this
230 section to sign a [
231 order, in accordance with Subsection (9)(a), by:
232 (i) signing a written revocation of the [
233 (ii) completing and signing a new [
234 (c) A surrogate may not revoke a [
235 time beginning when an emergency service provider is contacted for assistance, and ending
236 when the emergency ends.
237 (10) (a) The Department of Health shall [
238 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
239 (i) create the forms and systems described in this section; and
240 (ii) develop uniform instructions for the form established in Section 75-2a-117.
241 (b) The Department of Health may [
242 Chapter 3, Utah Administrative Rulemaking Act, to designate health care professionals, in
243 addition to those described in Subsection (2)(b)(ii), who may prepare a [
244 POLST order.
245 (c) The Department of Health may assist others with training of health care
246 professionals regarding this chapter.
247 (11) A physician assistant may not prepare or sign a [
248 unless the physician assistant is permitted to prepare or sign the [
249 order under the physician assistant's delegation of services agreement, as defined in Section
251 (12) (a) Notwithstanding any other provision of this section:
252 (i) the provisions of Title 46, Chapter 4, Uniform Electronic Transactions Act, apply to
253 any signature required on the POLST order; and
254 (ii) a verbal confirmation satisfies the requirement for a signature from an individual
255 under Subsection (3)(b)(ii) or (iii), if:
256 (A) requiring the individual described in Subsection (3)(b)(i)(B), (ii), or (iii) to sign the
257 POLST order in person or electronically would require significant difficulty or expense; and
258 (B) a licensed health care provider witnesses the verbal confirmation and signs the
259 POLST order attesting that the health care provider witnessed the verbal confirmation.
260 (b) The health care provider described in Subsection (12)(a)(ii)(B):
261 (i) may not be the same individual who signs the POLST order under Subsection
262 (3)(a); and
263 (ii) shall verify, in accordance with HIPAA as defined in Section 26-18-17, the identity
264 of the individual who is providing the verbal confirmation.